Healthcare Provider Details

I. General information

NPI: 1891293130
Provider Name (Legal Business Name): LATRICE M MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6322 LEDBETTER ST
HOUSTON TX
77087-5047
US

IV. Provider business mailing address

6322 LEDBETTER ST
HOUSTON TX
77087-5047
US

V. Phone/Fax

Practice location:
  • Phone: 225-385-4543
  • Fax: 866-825-9703
Mailing address:
  • Phone: 225-385-4543
  • Fax: 866-825-9703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: